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Neurological Complications in HIV Infection/AIDS

This study by Dr. K. Bujji Babu, MD, HIV Physician, discusses patient profiles, diagnostic challenges, treatment options, and limitations related to neurological complications in HIV/AIDS. The article highlights the significance of a multidisciplinary team approach involving HIV physicians, neurologists, radiologists, microbiologists, and pathologists. The research covers various conditions such as tubercular meningitis, cryptococcal meningitis, toxoplasmosis, PML, pneumococcal meningitis, HIV myelopathy with myopathy, facial palsy due to herpes zoster, peripheral neuropathy, and spinal masses. Issues like cerebral atrophy and neoplasms in patients with low CD4 counts are also addressed. The study underscores the challenges of managing neurological complications in HIV patients, emphasizing the importance of ART in improving outcomes.

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Neurological Complications in HIV Infection/AIDS

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  1. Neurological Complications in HIV Infection/AIDS Dr.K.Bujji Babu, MD., HIV Physician Consultant Bujji Babu HIV Clinic Kanuru Vijayawada

  2. Introduction • Deadly DUO in HIV infection --Opportunistic infections -- Neoplasms • Team effort -- HIV physician -- Neurologist -- Radiologist, Microbiologist & Pathologist

  3. AIMS • Discuss patient profiles in AIDS • Diagnostic dilemmas • Treatment: Options, Complications, Limitations

  4. Epidemiology • Duration: 2 years • Total no HIV/AIDS cases: 490 • No of patients with neurological complications:50 • Male:Female: 31:19 • Age group : 25-55 years

  5. Patient Profile • Clinical examinations • Laboratory Investigations • Confirmation of serological status by ELISA/W.B • Hb%, TC, DC, ESR, VDRL, Hep A,B & C, S.Bilirubin, S.Creatinine, S.Amylase, Serum IgG for Toxo, Montoux, CXR, USG abdomen, Urine examination • CD4 for Immunological status

  6. CNS Examination • Clinical Examination • Examination of fundus • Laboratory study CSF Study Chemical Analysis, AFB, Gramstain, Culture sensitivity, KOH, VDRL, Indian Ink Preparation for Crypto, Cryptococcal antigen, PCR. • MRI study

  7. Tubercular meningitis • No. of Patients: 8 (M:F-5:3) • Clinical Features: Fever, Headache & Vomiting • CSF Analysis AFB Positive for 3 (1F, 2 M) AFB Negative for 5 (1F, 4M) • CD4 count • Mortality: One patient died in advanced stage, even after shunting for TBM with hydrocephalous

  8. TB Spine • No. of Patients : 2 (M:F-1:1) • Clinical Features: Fever, Backache, Loss of weight • Diagnosis : MRI spine • Treatment : ATT followed by ART • Results:Therapeutic response very good both TBM & TB spine when the CD4 > 150

  9. Cryptococcal Meningitis • No. of patients: 8 [M:F- 5:3] • Clinical features: Throbbing Headache, Fever, Occasional Convulsions. • CD4 < 150 • CSF: High Pressure, Clear Fluid • Indian ink for Cryptococcus +ve (5 cases) • Cryptococcal antigen +ve (3 cases) • Treatment: Fluconazole 200mg IV BD, Amphotericin B 0.7mg/kg & followed by ART • Mortality: 2 [M:F-1:1]

  10. Toxoplasmosis • No. of Patients: 6 ( M:F- 5:1) • Clinical Features: Fever & Seizures • Diagnosis: Serum IgG Toxo, MRI • CD4 < 200 • Treatment: Anti TOXO Alternative: Clindamycin & Dapsone Followed by ART • Mortality: 1

  11. PML • No. of Patients: 6 (M:F- 4:2) • Clinical features: Loss of memory, irrelevant speech, insomnia • Diagnosis : MRI • CD4 <150 • Treatment: Symptomatic & ART • Mortality: 1

  12. Cerebral Atrophy • No. of Patients: 3 (M:F-2:1) • Clinical Features: Loss of memory,irrelevant speech,insomnia insomnia • Diagnosis – MRI • CD4 < 150 • Treatment: Symptomatic & ART

  13. Pneumococcal Meningitis • No. of patients – 2 (M) • Clinical Features: Fever, Headache and vomiting • Diagnosis: CSF analysis, Gram stain / CultureRx • Treatment : standard+ ART • Results: 1 patient died, CD4 = 27, one patient survive CD4 = 150

  14. HIV Myelopathy with Myopathy • 1 (F) patient • Clinical Features: Tingling sensation & weakness in lower limbs • CD4:110 • Treatment : ART

  15. Facial Palsy due to Herpes-Zoster • No. of cases: 6 (M:F-4:2) • Diagnosis – Clinical • CD4 < 200 • Treatment: Acyclovir , Famcyclovir , Valcyclovir Physiotherapy

  16. Peripheral Neuropathy • No. of Patients: 5 (M:F- 3: 2) • Cause : Mainly drug induced • Clinical Features: Numbness, tingling sensations & weakness in lower limbs • CD4 : 50 – 150 • Diagnosis : Clinical and NCS • Treatment : Vitamin supplements

  17. Spinal Masses Other than KOCH’s • No. of Patients: 3 (M:F- 2:1) • Clinical Features: Fever, Paraplegia,Urinary retention, Bowel incontinence • CD4; < 100 • Diagnosis: MRI & Biopsy • Results : 1(M) Secondary from renal cell Ca. - died 1(M) NHL operated - doing well 1(F) Spinal inflammatory/Neoplastic lesions nature not known (died because neutropenia)

  18. Conclusion TBM , Crypto, Toxo CD4 < 200 Cerebral atrophy & PML Neoplasms common CD4 <100 Neuro AIDS -- More common -- high morbidity -- Very high mortality -- ART

  19. Thank You

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